Disinfection gateways can prevent transmission of pathogens between distinct domains in hospitals and between hospitals.

How can we speed up progress?

We need to expand our view beyond the point of contact between patients and providers to think in terms of the overall process of transmission within a hospital and between care facilities.

Each transit across a boundary between domains should be considered as a potential “transmission” of pathogens that will infect a unit, ward, floor, building or care facility. At these boundaries, protocols of disinfection should be designed to reduce pathogen transfers from one domain to another. The boundaries between domains should be like airlocks, disinfecting people and objects that pass through them.

What protocols should these boundaries have? Since there are relatively few such crossings as compared to the number of patient contacts overall, we can consider more extensive decontamination procedures than just hand washing, such as clothing sanitation and the cleaning of cell phones and other personal effects. There is evidence that lab coats, PDAs, cell phones and the like act as repositories for pathogens, and can be responsible for HAI transmission. The protocol should still be efficient, and it can be. Staging such intensive interventions at the gateways could significantly reduce the flow of pathogens between patients.